 | This article needs more medical references for verification or relies too heavily on primary sources .(February 2022) |  |
| Tympanoplasty | |
|---|---|
 Before and after a tympanoplasty. | |
| Specialty | otolaryngology |
| ICD-9-CM | 19.4-19.5 |
| MeSH | D014433 |
Tympanoplasty is the surgical operation performed to reconstruct hearing mechanism of middle ear
Tympanoplasty is classified into five different types, originally described by Horst Ludwig Wullstein (1906–1987) in 1956. [1] [2]
The term 'myringoplasty' refers to repair of the tympanic membrane alone. [3] There are several options for treating a perforated eardrum. If the perforation is from recent trauma, many ear, nose and throat specialists will elect to watch and see if it heals on its own. After that, surgery may be considered.
This procedure is required if there is a damage to the bone chain of the middle ear. Commonly affected bone is the long process of incus, where it gets necrosed. The bone chain can be repaired using autograft of incus or cartilage. Prosthetic implants made of hydroxyapatite or teflon are also used.
Tympanoplasty can be performed through the ear canal (transcanal approach), through an incision in the ear (endaural approach) or through an incision behind the ear (postauricular approach). A graft may be taken to reconstruct the tympanic membrane. Common graft sites include the temporalis fascia and the tragus. The surgery takes 1⁄2 to 1 hour if done through the ear canal and 1+1⁄2 to 2 hours if an incision is needed. It is done under local or general anesthesia. It is done on an inpatient or day case basis and is successful 85-90% of the time. [4]
The first recorded attempt at repairing the tympanic membrane was made by Marcus Banzer [5] in 1640 using an ivory tube covered by pig's bladder.
In the middle of the nineteenth century the British otologists James Yearsley and Joseph Toynbee each developed their own form of artificial eardrum. Despite initial enthusiasm for these devices, experience amongst the medical profession over the following half century demonstrated their minimal value in the treatment of a perforated eardrum, which generally heals naturally. [6]
The middle ear is the portion of the ear medial to the eardrum, and distal to the oval window of the cochlea.
Cholesteatoma is a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. Cholesteatomas are not cancerous as the name may suggest, but can cause significant problems because of their erosive and expansile properties. This can result in the destruction of the bones of the middle ear (ossicles), as well as growth through the base of the skull into the brain. They often become infected and can result in chronically draining ears. Treatment almost always consists of surgical removal.
The ossicles are three bones in either middle ear that are among the smallest bones in the human body. They serve to transmit sounds from the air to the fluid-filled labyrinth (cochlea). The absence of the auditory ossicles would constitute a moderate-to-severe hearing loss. The term "ossicle" literally means "tiny bone". Though the term may refer to any small bone throughout the body, it typically refers to the malleus, incus, and stapes of the middle ear.
The incus or anvil is a bone in the middle ear. The anvil-shaped small bone is one of three ossicles in the middle ear. The incus receives vibrations from the malleus, to which it is connected laterally, and transmits these to the stapes medially. The incus is so-called because of its resemblance to an anvil.
The stapes or stirrup is a bone in the middle ear of humans and other animals which is involved in the conduction of sound vibrations to the inner ear. This bone is connected to the oval window by its annular ligament, which allows the footplate to transmit sound energy through the oval window into the inner ear. The stapes is the smallest and lightest bone in the human body, and is so-called because of its resemblance to a stirrup.
In the anatomy of humans and various other tetrapods, the eardrum, also called the tympanic membrane or myringa, is a thin, cone-shaped membrane that separates the external ear from the middle ear. Its function is to transmit sound from the air to the ossicles inside the middle ear, and then to the oval window in the fluid-filled cochlea. Hence, it ultimately converts and amplifies vibration in air to vibration in cochlear fluid. The malleus bone bridges the gap between the eardrum and the other ossicles.
A stapedectomy is a surgical procedure of the middle ear performed in order to improve hearing.
The ear is the organ that enables hearing and, in mammals, body balance using the vestibular system. In mammals, the ear is usually described as having three parts—the outer ear, the middle ear and the inner ear. The outer ear consists of the pinna and the ear canal. Since the outer ear is the only visible portion of the ear in most animals, the word "ear" often refers to the external part alone. The middle ear includes the tympanic cavity and the three ossicles. The inner ear sits in the bony labyrinth, and contains structures which are key to several senses: the semicircular canals, which enable balance and eye tracking when moving; the utricle and saccule, which enable balance when stationary; and the cochlea, which enables hearing. The ears of vertebrates are placed somewhat symmetrically on either side of the head, an arrangement that aids sound localisation.
Conductive hearing loss (CHL) occurs when there is a problem transferring sound waves anywhere along the pathway through the outer ear, tympanic membrane (eardrum), or middle ear (ossicles). If a conductive hearing loss occurs in conjunction with a sensorineural hearing loss, it is referred to as a mixed hearing loss. Depending upon the severity and nature of the conductive loss, this type of hearing impairment can often be treated with surgical intervention or pharmaceuticals to partially or, in some cases, fully restore hearing acuity to within normal range. However, cases of permanent or chronic conductive hearing loss may require other treatment modalities such as hearing aid devices to improve detection of sound and speech perception.
The tympanic cavity is a small cavity surrounding the bones of the middle ear. Within it sit the ossicles, three small bones that transmit vibrations used in the detection of sound.
Tympanometry is an acoustic evaluation of the condition of the middle ear eardrum and the conduction bones by creating variations of air pressure in the ear canal.
A perforated eardrum is a hole in the eardrum. It can be caused by infection, trauma, overpressure, inappropriate ear clearing, and changes in middle ear pressure. An otoscope can be used to view the eardrum to diagnose a perforation. Perforations may heal naturally, or require surgery.
The evolution of mammalian auditory ossicles was an evolutionary event that resulted in the formation of the bones of the mammalian middle ear. These bones, or ossicles, are a defining characteristic of all mammals. The event is well-documented and important as a demonstration of transitional forms and exaptation, the re-purposing of existing structures during evolution.
A mastoidectomy is a procedure performed to remove the mastoid air cells, air bubbles in the skull, near the inner ears. This can be done as part of treatment for mastoiditis, chronic suppurative otitis media or cholesteatoma. In addition, it is sometimes performed as part of other procedures or for access to the middle ear. There are classically 5 different types of mastoidectomy:
Myringoplasty is the closure of the perforation of pars tensa of the tympanic membrane. When myringoplasty is combined with removal of scar tissue, it is called tympanoplasty. The operation is performed with the patient supine and face turned to one side. The graft material most commonly used for the surgery is temporalis fascia. The tragal cartilage and tragal perichondrium are also used as the graft by some surgeons.
Tympanic membrane retraction describes a condition in which a part of the eardrum lies deeper within the ear than its normal position.
In the auditory system, the columella contributes to hearing in amphibians, reptiles and birds. The columella form thin, bony structures in the interior of the skull and serve the purpose of transmitting sounds from the eardrum. It is an evolutionary homolog of the stapes, one of the auditory ossicles in mammals.
In medicine, an ossicular replacement prosthesis is a device intended to be implanted for the functional reconstruction of segments of the ossicles and facilitates the conduction of sound waves from the tympanic membrane to the inner ear. There are two common types of ossicular replacement prostheses, the total ossicular replacement prosthesis (TORP) and partial ossicular replacement prosthesis (PORP). A TORP replaces the entire ossicular chain while a PORP replaces only the incus and malleus but not the stapes. Indications for use of an ossicular replacement prosthesis include:
Endoscopic ear surgery(EES) is a minimally invasive alternative to traditional ear surgery and is defined as the use of the rigid endoscope, as opposed to a surgical microscope, to visualize the middle and inner ear during otologic surgery. During endoscopic ear surgery the surgeon holds the endoscope in one hand while working in the ear with the other. To allow this kind of single-handed surgery, different surgical instruments have to be used. Endoscopic visualization has improved due to high-definition video imaging and wide-field endoscopy, and being less invasive, EES is gaining importance as an adjunct to microscopic ear surgery.
The malleus, or hammer, is a hammer-shaped small bone or ossicle of the middle ear. It connects with the incus, and is attached to the inner surface of the eardrum. The word is Latin for 'hammer' or 'mallet'. It transmits the sound vibrations from the eardrum to the incus (anvil).